John Kuhry envisioned the worst as he rushed to the Eden Prairie football field where his son Connor had just suffered a concussion.
"Get him to the emergency room," the father of four was thinking.
Kuhry drove straight onto the grassy practice field and began peppering his sixth-grader with questions. What was his name? Could he count to five forwards and backwards?
His son was amused. "Dad, why are you asking me that?"
Kuhry's response reflects a profound change emerging in youth sports across Minnesota, driven by rising parent concern over player safety and a seminal new state law governing the treatment of concussions in young athletes.
Doctors say they're seeing an uptick in clinic and ER visits by young athletes with headaches and head injuries. Thousands of volunteer coaches are getting online training in concussion symptoms. And on-field medics and coaches say they're taking less flak from parents when they pull injured athletes out of games.
"The parents look at it differently," said Jeannie Palmer of Northstar EMS, which provides medics for youth hockey and football games in Eden Prairie and Edina. "They're asking us more questions now. The coaches are much more likely to say, 'Yup, sit it out.'"
Last fall Minnesota joined two dozen other states that have laws regulating youth sports concussions. Minnesota's version requires training for all coaches and prohibits concussed athletes from returning to play without medical clearance.
The new rules have raised numerous concerns, including a fear that any young athlete with a mild head bump would be forced to see a doctor. So far, local doctors said that hasn't been the case.
In fact, Fairview's concussion clinic is seeing more real cases, said Dr. Sarah Lehnert. "Some that were being missed before aren't being missed."
Another sign that concussions are being taken seriously: More than 100 schools and athletic associations in Minnesota now provide preseason cognitive assessments, known as ImPACT tests, so those results can be compared with follow-up tests if an athlete suffers a concussion during the season. The Eagan Athletic Association has held free testing events for athletes as young as 11 -- going a step beyond what the state requires.
"I wasn't comfortable just stopping with complying with the law," said Sharon Stumpf, a member of the Eagan board.
The transition hasn't necessarily been smooth. The law doesn't specify the type of medical provider that must provide written authorization for athletes to return to play. It could be a doctor, nurse, medic, athletic trainer or chiropractor. "If it's in their scope of practice, we're OK with it," said David King of the Brain Injury Association of Minnesota.
The lack of specificity was a concession to critics who could have blocked the law's approval, he said. Some skeptics worried about the cost for families if the law required them to take children to doctors any time concussions were suspected. The end result is that sports clubs are deciding on their own what types of providers can OK players for sports again.
"It's just very confusing," said Rachel Winthrop, community liaison for the concussion clinic at HealthEast's Bethesda Hospital in St. Paul. "Everybody is doing something different."
The Eden Prairie Youth Football Association decided that only a doctor can make the call. Out of concern for concussions, the association also switched in fall 2010 to having emergency medical technicians (EMTs) on site for games instead of athletic trainers. Association president Jay Hansen said coaches can't overrule EMTs when they decide athletes need to come out of games.
Palmer estimated that Northstar EMS has seen a 20 percent increase in the past two years in the number of concussion assessments during football or hockey games. The increased speed and physical nature of sports has likely contributed to the increase, but Palmer said she suspects that her EMTs are now being called in to assess injuries that coaches or parents used to handle themselves.
The course of concussions can vary radically from one incident to another. Connor Kuhry was injured during a blocking drill, when a hit from behind caused him to carom into the player in front of him. He rested for a week in September -- missing his team's first game -- before returning to play.
Tim Wynne's oldest son needed only a week of rest after a hockey puck hit him in the head, even though he had no memory of the game when it was finished.
Recovery wasn't so easy for Wynne's 15-year-old daughter, Shannon, who played varsity soccer for Holy Angels. Standing firmly in "the wall" to guard against a free kick this fall, she had a ball rocket off her cheek. She popped up and finished the game, but days later had crushing headaches. She had to rest for a month, missing school and doing little more than watching TV to keep her headaches at bay.
"The soccer season came and went, you know, by the time she was feeling better," Wynne said. "It was actually pretty scary."
Hundreds of concussions
Roughly 1,000 athletes between ages 5 and 19 are hospitalized for sports-related concussions every year in this state, the Minnesota Department of Health estimates.
The risk level has long been studied at the high school level, which is why the Minnesota State High School League already has policies preventing concussed athletes from returning to play without medical clearance.
Research is now unveiling the risk at younger ages. A study last year examined ER visits for concussions among youths 8 to 18 and found that 40 percent involved children 13 and younger. The majority occurred during organized team sports, with football and hockey showing the highest rates.
To comply with the training requirement in Minnesota's law, most associations steer their coaches to a 30-minute online course by the U.S. Centers for Disease Control and Prevention. While coaches grumble about the burden, associations report more than 90 percent compliance.
Of all people, John Kuhry was one of the scofflaws at first. Coaching another son's basketball team, he was notified before the holidays that he had to complete training. He forgot, then got an e-mail in January saying he couldn't coach another game until he was certified. The next game was a day away.
"This is mandatory," the e-mail read in bold letters.
On the bright side, Kuhry aced the test. His personal experience with his son's concussion made sure of that.
Most coaches and parents are embracing the new stance, said Chris Mazurek, the Eden Prairie football coach who helped Kuhry's son when he suffered a concussion. Even with EMTs on the field for games, coaches are still the first people who might notice subtle changes in players coming off the field.
"We know the players," he said, "So if someone is identified with signs of a potential concussion, we want to address that right away."
Jeremy Olson • 612-673-7744